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Individual

BOGUM KWON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
833 NORTHERN BLVD, GREAT NECK, NY 11021-5315
(516) 498-8400
Mailing address
833 NORTHERN BLVD STE 160, GREAT NECK, NY 11021-5322
(516) 498-8400

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
021238
NY
363A00000X
Physician Assistant
363AS0400X
Surgical Physician Assistant

Other

Enumeration date
08/03/2017
Last updated
07/09/2025
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